Remote Workers' Compensation Claims Specialist

Old Republic Commercial Risk; Oakland (CA); On-site; USD 70,000 - 85,000; Full time

Job summary

Old Republic Commercial Risk, Oakland, CA, seeks a Claims professional specializing in Workers’ Compensation to independently investigate, evaluate and resolve complex claims. You will administer high-risk cases in accordance with statutes, policy provisions, and company guidelines.

Responsibilities include determining coverage, settlements, reserves, and subrogation, with collaboration across PMA nurses and vendors. Remote position with travel under 10% may be required.

Qualifications

• Bachelor's degree or four or more years of equivalent insurance experience.
• California jurisdiction experience.
• AIC designation or similar professional designation desired.
• License required or ability to obtain license within 90 days of employment in mandated states.
• Familiarity with medical terminology and/or Workers' Compensation.

Responsibilities

• Investigates assigned claims with minimal supervision, including complex cases.
• Determines coverage, compensability, subrogation potential, and second injury fund applicability.
• Alerts supervisors to potentially suspect claims.
• Ensures timely denial or payment of benefits per jurisdictional requirements.
• Establishes reserves with documented rationale and adjusts over the life of the claim.
• Negotiates settlements within authorized limits.
• Coordinates case plans for medical/disability management and litigation.
• Collaborates with PMA nurse professionals on return-to-work strategies.
• Manages vendor selection to balance expense and loss outcomes.
• Maintains best practices and clear communications with clients and internal teams.

Skills

Investigative skills

Analytical thinking

Communication skills

Customer service

Time management

Education

Bachelor's degree or 4+ years insurance experience

AIC designation desired

Tools

MS Office

MS Word

Excel

PowerPoint

Job description

Old Republic Commercial Risk, Oakland, CA, seeks a Claims professional specializing in Workers’ Compensation to independently investigate, evaluate and resolve complex claims. You will administer high-risk cases in accordance with statutes, policy provisions, and company guidelines.

Responsibilities include determining coverage, settlements, reserves, and subrogation, with collaboration across PMA nurses and vendors. Remote position with travel under 10% may be required.